The Herbal Medicine Suanzaoren (Ziziphi Spinosae Semen) for Sleep Quality Improvements: A Systematic Review and Meta-analysis.

BACKGROUND: Sleep disturbances are common and bothersome among cancer and noncancer populations. Suanzaoren (Ziziphi Spinosae Semen) is commonly used to improve sleep, yet its efficacy and safety are unclear. METHODS: We systematically searched PubMed, Cochrane Library, and EMBASE from inception through October 5, 2021, to identify randomized trials of Suanzaoren. We included randomized trials comparing Suanzaoren to placebo, medications, cognitive behavioral therapy (CBT), or usual care for improving sleep outcomes in cancer and noncancer patients with insomnia or sleep disturbance. We performed a risk of bias analysis following Cochrane guidelines. Depending on heterogeneity, we pooled studies with similar comparators using fixed- and random-effects models. RESULTS: We included participants with insomnia disorder (N = 785) or sleep disturbance (N = 120) from 9 trials. Compared with placebo, Suanzaoren led to significant subjective sleep quality improvements in participants with insomnia and patients with sleep disturbance combined (standard mean difference -0.58, 95% CI -1.04, -0.11; P < .01); Compared with benzodiazepines or CBT, Suanzaoren was associated with a significant decrease in insomnia severity (mean difference -2.68 points, 95% CI -5.50, -0.22; P = .03) at 4 weeks in the general population and cancer patients. The long-term effects of Suanzaoren were mixed among trials. Suanzaoren did not increase the incidence of major adverse events. The placebo-controlled studies had a low risk of bias. CONCLUSION: Suanzaoren is associated with short-term patient-reported sleep quality improvements among individuals with insomnia or sleep disturbance. Due to the small sample size and variable study quality, the clinical benefits and harms of Suanzaoren, particularly in the long term, should be further assessed in a sufficiently powered randomized trial. REGISTRATION: PROSPERO CRD42021281943.

Coordinate-based (ALE) meta-analysis of acupuncture for musculoskeletal pain.

Background: Neuroimaging studies have been widely used to investigate brain regions' alterations in musculoskeletal pain patients. However, inconsistent results have hindered our understanding of the central modulatory effects of acupuncture for musculoskeletal pain. The main objective of our investigation has been to obtain comprehensive evidence of acupuncture for musculoskeletal pain diseases. Methods: The PubMed, Web of Science, Google Scholar, Embase, China National Knowledge Infrastructure (CNKI), VIP Database, China Biology Medicine disc Database, Clinical Trial Registration Platform, and Wanfang Database were searched for neuroimaging studies on musculoskeletal pain diseases published from inception up to November 2021. Then, the relevant literature was screened to extract the coordinates that meet the criteria. Finally, the coordinate-based meta-analysis was performed using the activation likelihood estimation algorithm. Results: A total of 15 neuroimaging studies with 183 foci of activation were included in this study. The ALE meta-analysis revealed activated clusters in multiple cortical and sub-cortical brain structures in response to acupuncture across studies, including the thalamus, insula, caudate, claustrum, and lentiform nucleus. Conclusions: The studies showed that acupuncture could modulate different brain regions, including the thalamus, insula, caudate, claustrum, and lentiform nucleus. The findings offer several insights into the potential mechanisms of acupuncture for musculoskeletal pain and provide a possible explanation for the observed clinical benefit of this therapy. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227850, identifier: CRD42021227850.

Effect of Acupuncture on Blood Pressure and Metabolic Profile Among Patients With Essential Hypertension: Protocol of a Randomized Clinical Trial.

Essential hypertension is a polygenic cardiovascular disease that is associated with maladaptive metabolic changes. Acupuncture as a non-pharmacologic intervention is used to lower blood pressure and improve metabolic dysfunction. However, such effects have not been clinically characterized. We will conduct a randomized clinical trial to evaluate the antihypertensive effect of acupuncture among patients with essential hypertension and determine the associated metabolic improvements. This study is a phase II, two-arm, randomized, sham-controlled trial (Trial registration: ChiCTR2100043737), in which biospecimens will be collected for metabolic profiling. A total of 64 patients with a clinical diagnosis of essential hypertension will be randomly assigned to either the acupuncture or the sham acupuncture group in a 1:1 ratio. All participants will receive 10 treatments over 4 weeks, with three sessions per week for the first 2 weeks and two sessions per week for the remaining weeks. The primary outcome is the change of the systolic and diastolic blood pressure measured by the 24-h ambulatory blood pressure monitoring from baseline to 4 weeks. Secondary outcomes include the circadian rhythm of blood pressure, sleep quality measured by the Insomnia Severity Index, cognitive function measured by the Montreal Cognitive Assessment, and others. Fasting blood serum and urine samples will be collected at baseline and 4 weeks for targeted and untargeted metabolomics analysis. We will use the mixed-effects model and other related bioinformatics approaches to analyze the clinical and metabolome data. This metabolomic-based trial will provide important clinical data regarding the efficacy of acupuncture for essential hypertension to better inform evidence-based care delivery for hypertension patients. Moreover, the findings will offer important insights into the mechanism of action of acupuncture for hypertension by revealing its effect on metabolism. The results of this study will be used to inform the design of a statistically powered, multicenter, randomized trial. We will publish the study findings in peer-reviewed journals. The ethical approval of this study has been reviewed and approved by the Sichuan Regional Ethics Review Committee on Traditional Chinese Medicine (ID: 2021KL-006). The outcomes of the trial will be disseminated through peer-reviewed publications.

Acupuncture Modulation Effect on Pain Processing Patterns in Patients With Migraine Without Aura.

INTRODUCTION: In this retrospective study, resting-state functional connectivity (FC) in patients with migraine was analyzed to identify potential pathological pain processing patterns and compared them to those in healthy controls (HCs). The FC patterns in patients between pre- and post-acupuncture sessions were also analyzed to determine how acupuncture affects neurological activity and pain perception during the migraine interictal period. METHODS: In total, 52 patients with migraine without aura (MwoA) and 60 HCs were recruited. Patients with migraine were given acupuncture treatment sessions for 4 weeks. As a primary observation, functional magnetic resonance images were obtained at the beginning and end of the sessions. HCs received no treatment and underwent one functional magnetic resonance imaging (fMRI) scan after enrollment. After the fMRI data were preprocessed, a region of interest (ROI)-to-ROI analysis was performed with predefined ROIs related to pain processing regions. RESULTS: The first analysis showed significantly different FCs between patients with MwoA and HCs [false discovery rate corrected p-value (p-FDR) < 0.05]. The FCs were found to be mainly between the cingulate gyrus (CG) and the insular gyrus, the CG and the inferior parietal lobule (IPL), the CG and the superior frontal gyrus, and the middle frontal gyrus and the IPL. The second analysis indicated that acupuncture treatment partly restored the different FCs found in the first analysis (p-FDR < 0.05). Furthermore, subgroup analysis found different brain activity patterns in headache-intensity restored condition and headache-frequency restored condition. Lastly, the correlation analysis suggested a potential correlation between FCs and clinical symptoms (p < 0.05). CONCLUSION: This study suggests that pain processing is abnormal in migraine, with significantly abnormal FCs in the frontal, parietal, and limbic regions. This finding could be a typical pathological feature of migraine. Acupuncture has been identified to relieve headache symptoms in two ways: it restores the pain processing function and regulates pain perception.

Mitochondrial signaling for histamine releases in laser-irradiated RBL-2H3 mast cells.

BACKGROUND: The low power laser irradiation (LPLI) can promote the wound healing, but the mechanism is still not fully understood. We have found in our previous work that the LPLI induces mast cells to release the histamine and thus suggested that the increased histamine release is probably one of the causes for promoting the wound healing since mast cells have been found to play positive roles in the process of wound healing. This study aims to explore the mechanism of histamine release in RBL-2H3 mast cells under laser irradiations. MATERIALS AND METHODS: The wavelength effect of laser irradiations, the permeability function of mitochondrial membrane, the Bcl-2 effect, the cytosolic alkalinization and the increment of intracellular Ca(2+) ([Ca(2+)](i)), on histamine release in RBL-2H3 cells were studied, respectively, with the corresponding fluorescence probes. RESULTS: The action bands of laser irradiations were consistent with the absorption bands of cytochrome c oxidase, suggesting that cytochrome c oxidase is the photoacceptor. After laser irradiation, (1) the cytochrome c releases from mitochondrial to cytosol reflecting an increased permeability of mitochondrial membrane, (2) the cytosolic alkalinization appears, (3) [Ca(2+)](i) increases, and (4) finally the enhancement of histamine release occurs. When Bcl-2 was used to inhibit the permeability of mitochondrial membrane these cellular signaling from (1) to (4) were all suppressed obviously. CONCLUSION: As a photoacceptor, cytochrome c oxidase absorbs incident photons and initiates the mitochondrial signaling. When the signals are transferred from the mitochondrial to the cytosol, the cytosolic alkalinization appears leading to the opening of a Ca(2+) channel on the membrane, the transient receptor potential vanilloid (TRPV), and an increment of [Ca(2+)](i). The increased [Ca(2+)](i) consequently mediates an enhanced histamine release. Such a responding chain is a suggested mechanism to understand the histamine release in RBL-2H3 cells under laser irradiations.

Effects of shear stress on intracellular calcium change and histamine release in rat basophilic leukemia (RBL-2H3) cells.

Massage, one form of physical therapy, is widely used for a large number of musculoskeletal disorders, but its exact mechanism still remains to be elucidated. One hypothesis is that the shear stress caused by massage may induce cutaneous mast cells to release histamine, thereby improving the local tissue microcirculation of blood. In the present work, a mast cell line (rat basophilic leukemia cells, RBL-2H3) was used in vitro to study cellular responses to the stimulus of shear stress generated by a rotating rotor in a cell dish. The intracellular calcium ([Ca2+]c) was studied by confocal fluorescence microscopy with Fluo-3/AM staining and the released histamine was measured with a fluorescence spectrometer using o-phthalaldehyde (OPA) staining. An elevation of [Ca2+]c occurred immediately after the shear stress, followed by histamine release. However, both [Ca2+]c increase and histamine release disappeared when a Ca2+-free saline was used, indicating that the rise in the [Ca2+]c is due to a Ca2+ influx from the extracellular buffer. Furthermore, Ruthenium red, a transient receptor potential vanilloid (TRPV) inhibitor, could effectively block the shear stressinduced histamine release, suggesting that TRPV membrane proteins are the likely targets of the shear stress. Because histamine is a well-known mediator of microvascular tissue dilation, these results may have an important impact on understanding the mechanism involved in massage therapy.